Sestopali Fund for Gastrointestinal Cancer Prevention, Department of Gastroenterology, Tel Aviv Medical Center, 6 Weizmann Street, 64239 Tel Aviv, Israel.
Dig Dis Sci. 2012 Aug;57(8):2203-12. doi: 10.1007/s10620-012-2146-z. Epub 2012 Apr 1.
There is renewed interest in flexible sigmoidoscopy (FS) colorectal cancer (CRC) screening following trials showing significantly reduced CRC incidence and mortality.
To evaluate the potential usefulness of FS screening in our population.
We examined rectosigmoid (RS) cancer epidemiology in our Jewish population using Israel National Cancer Registry data, computed by CRC site, age groups, and gender. We also reviewed endoscopy-screening publications for prevalence of RS and proximal advanced adenomas (AAP) and having both or either.
During 1980-2008, there were 64,559 CRCs registered; 31.6 % were RS cancer which has now decreased to 29 % of men's and 26 % of women's CRC (both P < 0.01). In <50 year olds, RS cancer occurred in 42 % of males' and 35 % of females' CRC, and in the last 2 decades this ratio is unchanged. In 50-74 year olds, RS cancer decreased to stable levels of 32 % of males' and 29 % females' CRC (both P < 0.01). In ≥75 year olds, RS cancer progressively decreased to 24 % of males' and 22 % females' CRC (both P < 0.001). From endoscopy screening reports in 40-79 year olds, RS AAPs occurred in 2.0-5.8 %, being least in women, most in men, and not increased with aging. Some 50-57 % of screenees had both RS and proximal AAPs, least when aged 40-49 years at 25 %, women were 35 %, and with aging 40 %, but most in men at 70 %.
With the changing CRC epidemiology, having fewer RS neoplasms but more proximal cancer, the effectiveness of FS screening for identifying significant neoplasms decreases with screenees' age and especially in females. These make FS screening less suitable for our aging and increasingly female population.
在多项试验表明，柔性乙状结肠镜（FS）结直肠癌（CRC）筛查可显著降低 CRC 的发病率和死亡率后，人们对其重新产生了兴趣。
评估 FS 筛查在我们人群中的潜在作用。
我们利用以色列国家癌症登记处的数据，根据 CRC 部位、年龄组和性别，研究了我们的犹太人群的直肠乙状结肠（RS）癌流行病学。我们还查阅了结直肠内镜筛查相关文献，以了解 RS 和近端高级腺瘤（AAP）的检出率以及同时检出两者的情况。
在 1980 年至 2008 年期间，共登记了 64559 例 CRC，其中 31.6%为 RS 癌，现在已降至男性的 29%和女性的 26%（均<0.01）。在<50 岁的人群中，男性和女性的 CRC 中 RS 癌的发生率分别为 42%和 35%，且在过去 20 年中，这一比例保持不变。在 50-74 岁的人群中，RS 癌降至男性和女性 CRC 的稳定水平，分别为 32%和 29%（均<0.01）。在≥75 岁的人群中，RS 癌逐渐降至男性和女性 CRC 的 24%和 22%（均<0.001）。从 40-79 岁人群的内镜筛查报告来看，RS AAP 的发生率为 2.0%-5.8%，女性最低，男性最高，且不随年龄增长而增加。约 50-57%的受检者同时患有 RS 和近端 AAP，40-49 岁时发生率最低，为 25%，女性为 35%，随着年龄增长为 40%，但男性最高，为 70%。
随着 CRC 流行病学的变化，RS 肿瘤数量减少，但近端癌症增多，FS 筛查识别重大肿瘤的有效性随受检者年龄的增加而降低，尤其是女性。这使得 FS 筛查对我们不断老龄化且女性人口比例不断增加的人群不太适用。
